Butterfly rash

A 62-year-old woman currently taking an antiarrhythmic to maintain normal sinus rhythm has a sudden onset of malaise and develops a "butterfly rash " Vitals T 38.4°C, BP 140/95 mm Hg, HR 90 beats/min, RR 16 breaths/min. Stat labs ANA positive. Which of the following drugs is the most likely cause of these findings ... 

But Chris had an early diagnosis because of two circumstances. First, she had the typical butterfly rash on her face. The rash, with open sores in her case, is distributed in a butterfly configuration across the eyes and nose. That sign should scream lupus to any intelligent doctor. 

Manifestations in the skin are nearly as common as those involving the musculoskeletal system. " The most well known of these is the butterfly rash, which occurs over the bridge of the nose and the malar eminences. The classic butterfly rash is seen in approximately one-half of patients and often is observed after sun exposure. In fact, photosensitivity is common to many SLE patients who present with cutaneous manifestations. Skin lesions characteristic of discoid lupus occur in 10% to 20% of patients with SLE and may occur without other clinical or serologic evidence of lupus. Some individuals are said to develop subacute cutaneous lupus erythematosus, the nature of whose lesions falls between discoid (one type of chronic... 

Systemic lupus erythematosus is a systemic inflammatory disease with formation of autoantibodies against DNA, wide spread immune complex deposition and complement activation. Symptoms include arthritis, a characteristic butterfly rash on the face, myalgia, glomerulonephritis, vasculitis, pericarditis and inflamed and fibrosed lungs. 

Chloroquine, an antimalarial, to a client with a butterfly rash. 

Juvenile dermatomyositis (JDM) is perhaps the most uniform, in terms of clinical and histopathological features, of the whole PM/DM disease complex. Presentation may be before 5 years of age with peak incidence between 8 and 12 years. The disease may remit and recur until well into young adult life. The skin lesions include a facial rash in butterfly distribution across nose and cheeks. Erythematous skin changes are seen over extensor surfaces of joints, especially knees, knuckles and elbows. Muscle involvement is generally evident some time later and takes the form of weakness and stiffness, particularly affecting shoulder and pelvic musculature. Proximal muscles are often worse affected than distal muscles and extensors worse than flexors. In the absence of prompt and effective treatment contractures may occur at elbows, ankles, knees, and hips. Subcutaneous calcification and skin ulceration may be found calcification of deeper-lying connective tissue may be apparent on X-ray. 

Methyldopa is the only antihypertensive drug associated with hemolytic anemia (usually preceded by a positive Coombs test). Hydralazine is also associated with autoimmune toxicity, but this takes the form of a lupus-like syndrome with butterfly facial rash, fever, joint and muscle pains, and antinuclear antibodies. The answer is (D). 

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